Mental health services during the first wave of the COVID-19 pandemic in Europe: Results from the EPA Ambassadors Survey and implications for clinical practice

doi:10.1192/j.eurpsy.2021.2215

. 2021 Jun 9;64(1):e41.

doi: 10.1192/j.eurpsy.2021.2215.

Mental health services during the first wave of the COVID-19 pandemic in Europe: Results from the EPA Ambassadors Survey and implications for clinical practice

Martina Rojnic Kuzman¹, Simavi Vahip², Andrea Fiorillo³, Julian Beezhold⁴, Mariana Pinto da Costa^{5

6}, Oleg Skugarevsky⁷, Geert Dom⁸, Izet Pajevic⁹, Alma Mihaljevic Peles^{1

10}, Pavel Mohr^{11

12}, Anne Kleinberg¹³, Eka Chkonia^{14

15}, Judit Balazs^{16

17}, William Flannery¹⁸, Ramune Mazaliauskiene¹⁹, Jana Chihai²⁰, Jerzy Samochowiec²¹, Doina Cozman²², Goran Mihajlovic²³, Lubomira Izakova²⁴, Celso Arango²⁵, Philip Goorwod^{26

27}

Affiliations

¹ Zagreb School of Medicine, Zagreb University Hospital Centre, Zagreb, Croatia.
² Department of Psychiatry, Ege University Medicine Faculty, Affective Disorders Unit, Izmir, Turkey.
³ Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy.
⁴ Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
⁵ Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
⁶ Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal.
⁷ Psychiatry & Medical Psychology Department, Belarusian Psychiatric Association, Belarusian State Medical University, Minsk, Belarus.
⁸ Belgian Professional Association of Medical Specialists in Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (UAntwerp), Antwerp, Belgium.
⁹ Department of Psychiatry University Clinical Center Tuzla, School of Medicine University of Tuzla, Bosnia and Herzegovina Psychiatric Association of Bosnia-Herzegovina, Tuzla, Bosnia-Herzegovina.
¹⁰ Croatian Psychiatric Association, Zagreb, Croatia.
¹¹ Czech Psychiatric Association, National Institute of Mental Health, Klecany, Czechia.
¹² Third Faculty of Medicine, Charles University, Prague, Czech Republic.
¹³ Tallinn Children Hospital Children Mental Health, Tallinn, Estonia.
¹⁴ Estonian Psychiatric Association, Centre Tartu University Psychiatry Clinic, TartuEstonia.
¹⁵ Society of Georgian Psychiatrists, Tbilisi State Medical University, Tbilisi, Georgia.
¹⁶ Department of Developmental and Clinical Child Psychology, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.
¹⁷ Hungarian Psychiatric Association, Bjørknes University College, Oslo, Norway.
¹⁸ Department of Adult Psychiatry, College of Psychiatrists of Ireland, Mater Misericordiae University Hospital, Dublin, Ireland.
¹⁹ Lithuanian Psychiatric Association, Lithuanian Health Sciences university, Psychiatric Clinic, Lithuanian Health Sciences university Kaunas hospital, Kaunas, Lithuania.
²⁰ Society of Psychiatrists, Narcologists, Psychotherapists and Clinical Psychologists from Republic of Moldova, Department of Psychiatry, Narcology, Medical Psychology State Medical and Pharmaceutical University "Nicolae Testemitanu" from Republic of Moldova, Kishinev, Moldova.
²¹ Polish Psychiatric Association, Department of Psychiatry, Pomeranian Medical University in Szczecin Poland, Szczecin, Poland.
²² Romanian Association of Psychiatry and Psychotherapy, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania.
²³ Department of Psychiatry, Faculty of Medical Science, University of Kragujevac, Kragujevac, Serbia.
²⁴ Slovak Psychiatric Association, Department of Psychiatry, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia.
²⁵ Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain.
²⁶ INSERM, U1266 (Institute of Psychiatry and Neuroscience of Paris), Université de Paris, Paris, France.
²⁷ CMME, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France.

PMID: 34103102
PMCID: PMC8314055
DOI: 10.1192/j.eurpsy.2021.2215

Mental health services during the first wave of the COVID-19 pandemic in Europe: Results from the EPA Ambassadors Survey and implications for clinical practice

Martina Rojnic Kuzman et al. Eur Psychiatry. 2021.

. 2021 Jun 9;64(1):e41.

doi: 10.1192/j.eurpsy.2021.2215.

Authors

Affiliations

¹ Zagreb School of Medicine, Zagreb University Hospital Centre, Zagreb, Croatia.
² Department of Psychiatry, Ege University Medicine Faculty, Affective Disorders Unit, Izmir, Turkey.
³ Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy.
⁴ Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
⁵ Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
⁶ Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal.
⁷ Psychiatry & Medical Psychology Department, Belarusian Psychiatric Association, Belarusian State Medical University, Minsk, Belarus.
⁸ Belgian Professional Association of Medical Specialists in Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (UAntwerp), Antwerp, Belgium.
⁹ Department of Psychiatry University Clinical Center Tuzla, School of Medicine University of Tuzla, Bosnia and Herzegovina Psychiatric Association of Bosnia-Herzegovina, Tuzla, Bosnia-Herzegovina.
¹⁰ Croatian Psychiatric Association, Zagreb, Croatia.
¹¹ Czech Psychiatric Association, National Institute of Mental Health, Klecany, Czechia.
¹² Third Faculty of Medicine, Charles University, Prague, Czech Republic.
¹³ Tallinn Children Hospital Children Mental Health, Tallinn, Estonia.
¹⁴ Estonian Psychiatric Association, Centre Tartu University Psychiatry Clinic, TartuEstonia.
¹⁵ Society of Georgian Psychiatrists, Tbilisi State Medical University, Tbilisi, Georgia.
¹⁶ Department of Developmental and Clinical Child Psychology, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.
¹⁷ Hungarian Psychiatric Association, Bjørknes University College, Oslo, Norway.
¹⁸ Department of Adult Psychiatry, College of Psychiatrists of Ireland, Mater Misericordiae University Hospital, Dublin, Ireland.
¹⁹ Lithuanian Psychiatric Association, Lithuanian Health Sciences university, Psychiatric Clinic, Lithuanian Health Sciences university Kaunas hospital, Kaunas, Lithuania.
²⁰ Society of Psychiatrists, Narcologists, Psychotherapists and Clinical Psychologists from Republic of Moldova, Department of Psychiatry, Narcology, Medical Psychology State Medical and Pharmaceutical University "Nicolae Testemitanu" from Republic of Moldova, Kishinev, Moldova.
²¹ Polish Psychiatric Association, Department of Psychiatry, Pomeranian Medical University in Szczecin Poland, Szczecin, Poland.
²² Romanian Association of Psychiatry and Psychotherapy, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania.
²³ Department of Psychiatry, Faculty of Medical Science, University of Kragujevac, Kragujevac, Serbia.
²⁴ Slovak Psychiatric Association, Department of Psychiatry, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia.
²⁵ Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain.
²⁶ INSERM, U1266 (Institute of Psychiatry and Neuroscience of Paris), Université de Paris, Paris, France.
²⁷ CMME, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France.

PMID: 34103102
PMCID: PMC8314055
DOI: 10.1192/j.eurpsy.2021.2215

Abstract

Background: The COVID-19 pandemic caused an unprecedented worldwide crisis affecting several sectors, including health, social care, economy and society at large. The World Health Organisation has emphasized that mental health care should be considered as one of the core sectors within the overall COVID-19 health response. By March 2020, recommendations for the organization of mental health services across Europe have been developed by several national and international mental health professional associations.

Methods: The European Psychiatric Association (EPA) surveyed a large European sample of psychiatrists, namely the "EPA Ambassadors", on their clinical experience of the impact of COVID-19 pandemic on the treatment of psychiatric patients during the month of April 2020 in order to: a) identify and report the views and experiences of European psychiatrists; and b) represent and share these results with mental health policy makers at European level. Based on the recommendations issued by national psychiatric associations and on the results of our survey, we identified important organisational aspects of mental health care during the peak of the first wave of the COVID-19.

Results: While most of the recommendations followed the same principles, significant differences between countries emerged in service delivery, mainly relating to referrals to outpatients and for inpatient admission, assessments and treatment for people with mental disorders. Compared to previous months, the mean number of patients treated by psychiatrists in outpatient settings halved in April 2020. In the same period, the number of mentally ill patients tested for, or developing, COVID-19 was low. In most of countries, traditional face-to-face visits were replaced by online remote consultations.

Conclusions: Based on our findings we recommend: 1) to implement professional guidelines into practice and harmonize psychiatric clinical practice across Europe; 2) to monitor the treatment outcomes of patients with COVID-19 and pre-existing mental disorders; 3) to keep psychiatric services active by using all available options (for example telepsychiatry); 4) to increase communication and cooperation between different health care providers.

Keywords: COVID-19; Europe; mental health services.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

**Figure 1.**
Estimation of the percentage of on-line services provided instead of face-to-face consultations by mental health professionals in April 2020 across European countries. Countries with a number of responses lower than 5 were not shown.

**Figure 2.**
Predominant model of service for persons with pre-existing mental health problems infected with SARS-CoV-2 in April 2020 across European countries. Countries with a number of responses lower than 5 were not shown.

**Figure 3.**
Cooperation between healthcare providers during April 2020 compared to the period before COVID-19 pandemic.

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References

1. World Health Organisation. Guidelines to help countries maintain essential health services during the COVID-19 pandemic, https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technica...; 2019 [accessed 30 March 2020].
1. Fiorillo A, Gorwood P. The consequences of the COVID-19 pandemic on mental health and implications for clinical practice. Eur Psychiatry. 2020;1;63(1):e32. doi:10.1192/j.eurpsy.2020.35. - DOI - PMC - PubMed
1. Moreno C, Wykes T, Galderisi S, Nordentoft M, Crossley N, Jones N et al. How mental health care should change as a consequence of the COVID-19 pandemic. Lancet Psychiatry. 2020;7(9):813–24. doi:10.1016/S2215-0366(20)30307-2. - DOI - PMC - PubMed
1. Varatharaj A, Thomas N, Ellul MA, Davies NWS, Pollak TA, Tenorio EL. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study. Lancet Psychiatry. 2020;7(10):875–82. doi:10.1016/S2215-0366(20)30287-X. - DOI - PMC - PubMed
1. Czeisler MÉ, Lane RI, Petrosky E, Wiley JF, Christensen A, Njai R, et al. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic: United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(32):1049–57. doi:10.15585/mmwr.mm6932a1. - DOI - PMC - PubMed

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[1] World Health Organisation. Guidelines to help countries maintain essential health services during the COVID-19 pandemic, https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technica...; 2019 [accessed 30 March 2020].

[2] World Health Organisation. Guidelines to help countries maintain essential health services during the COVID-19 pandemic, https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technica...; 2019 [accessed 30 March 2020].

[3] Fiorillo A, Gorwood P. The consequences of the COVID-19 pandemic on mental health and implications for clinical practice. Eur Psychiatry. 2020;1;63(1):e32. doi:10.1192/j.eurpsy.2020.35. - DOI - PMC - PubMed

[4] Fiorillo A, Gorwood P. The consequences of the COVID-19 pandemic on mental health and implications for clinical practice. Eur Psychiatry. 2020;1;63(1):e32. doi:10.1192/j.eurpsy.2020.35. - DOI - PMC - PubMed

[5] Moreno C, Wykes T, Galderisi S, Nordentoft M, Crossley N, Jones N et al. How mental health care should change as a consequence of the COVID-19 pandemic. Lancet Psychiatry. 2020;7(9):813–24. doi:10.1016/S2215-0366(20)30307-2. - DOI - PMC - PubMed

[6] Moreno C, Wykes T, Galderisi S, Nordentoft M, Crossley N, Jones N et al. How mental health care should change as a consequence of the COVID-19 pandemic. Lancet Psychiatry. 2020;7(9):813–24. doi:10.1016/S2215-0366(20)30307-2. - DOI - PMC - PubMed

[7] Varatharaj A, Thomas N, Ellul MA, Davies NWS, Pollak TA, Tenorio EL. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study. Lancet Psychiatry. 2020;7(10):875–82. doi:10.1016/S2215-0366(20)30287-X. - DOI - PMC - PubMed

[8] Varatharaj A, Thomas N, Ellul MA, Davies NWS, Pollak TA, Tenorio EL. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study. Lancet Psychiatry. 2020;7(10):875–82. doi:10.1016/S2215-0366(20)30287-X. - DOI - PMC - PubMed

[9] Czeisler MÉ, Lane RI, Petrosky E, Wiley JF, Christensen A, Njai R, et al. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic: United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(32):1049–57. doi:10.15585/mmwr.mm6932a1. - DOI - PMC - PubMed

[10] Czeisler MÉ, Lane RI, Petrosky E, Wiley JF, Christensen A, Njai R, et al. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic: United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(32):1049–57. doi:10.15585/mmwr.mm6932a1. - DOI - PMC - PubMed

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Mental health services during the first wave of the COVID-19 pandemic in Europe: Results from the EPA Ambassadors Survey and implications for clinical practice

Affiliations

Mental health services during the first wave of the COVID-19 pandemic in Europe: Results from the EPA Ambassadors Survey and implications for clinical practice

Authors

Affiliations

Abstract

Conflict of interest statement

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